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Anchor lead: Abuse may complicate healthcare for women, Elizabeth Tracey reports

Health consequences of abuse to women, whether that’s something that happened when they were children or adults, impacts on their management of chronic health problems. That’s according to Carmen Alvarez, a researcher on women’s health issues at the Johns Hopkins School of Nursing.

Alvarez: There is an association between child abuse, adult abuse, so intimate partner violence, and poorer health outcomes. Women who do have a chronic illness and a history of trauma are different from those who have a chronic illness alone, that those with chronic illness and a history of trauma are greater utilizers of care. How can we encourage providers to know when they really need to engage patients a bit more?  :27

Alvarez says providers need to be aware of their opportunity to empower women with a history of abuse to adopt healthy behaviors and recognize how their own history may be compromising them in healing. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How does smoking lead to harm for fetuses? Elizabeth Tracey reports

Everyone knows that pregnant women shouldn’t smoke, with a Johns Hopkins study under the direction of Kristen Voegtline perhaps identifying one way cigarette smoke exposure may harm the developing baby, via the addition of a chemical group known as a methyl group to a specific gene.

Voegtline: We’ve used this opportunity to look at prenatal exposure to cigarette smoking. With that we find that there’s a methylation difference in boys. So boys that are exposed to prenatal cigarette smoking show greater methylation, specifically at this site in the gene called cip1a1, this is a detoxifying gene. So the fact that males may detoxify an adverse exposure differently than girls, where we didn’t find a difference, we find to be potentially very interesting. :29

Voegtline says that this identification may one day be used as a biomarker to assess risk, but for now, reiterates the fact that smoking is known to be harmful to a developing fetus so the best exposure is no exposure. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Depression treatment for younger people needs attention, Elizabeth Tracey reports

Depression is this year’s focus for the World Health Organization, and Patricia Davidson, dean of the Johns Hopkins School of Nursing, says a particular emphasis must be on the recognition and treatment of depression in younger people, who may turn to suicide attempts when the condition persists.

Davidson: That underscores the importance of the media in how we communicate these issues. It also compels us to look at how we engage young individuals in terms of treatment of depression. Also access to guns. Swallowing a handful of pills there is some chance of detoxing and perhaps reversing the effects of what could be perceived as an impulsive act. But sadly, a fatal wound to the heart or the brain, is terminal.   :33

Davidson says we do have treatment strategies that work for depression, but these must be preceded by recognition. At Johns Hopkins, I’m Elizabeth Tracey.

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Confident smiling doctor posing and looking at camera with arms crossed, medical staff working on the background

This week’s topics include physician age and outcomes, abortion via telemedicine, age to begin screening for cardiovascular disease, and vaccination of travelers.

Program notes:
0:31 Physician age and patient outcomes
1:30 Lower for physicians under 40
2:30 More up to date on newer treatments?
3:30 Older physicians should embrace
3:42 Abortion via telemedicine
4:44 Uses a website
5:44 Large majority medical rather than surgical
6:24 Vaccination among travelers
7:24 Can’t prove you’ve had measles vaccine
8:20 Risk of cardiovascular disease among young
9:20 Don’t have high blood pressure and don’t smoke
10:37 End
Related blog: https://podblog.blogs.hopkinsmedicine.org/2017/05/21/physician-age-and-death-in-the-hospital/
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Anchor lead: Asking why some people with Marfan syndrome don’t have its worst consequences has led to new ways to intervene, Elizabeth Tracey reports

Even when someone has the genetic make-up to develop Marfan syndrome, a connective tissue disorder that can lead to rupture of the aorta and death, there are people who don’t develop such a consequence. Hal Dietz, a Marfan expert at Johns Hopkins, and colleagues, studied those people to find out what was protecting them.

Dietz: Quite remarkably, using five truly exceptional families, showing this dramatic degree of variation, we were able to show that a single region of a specific chromosome was passing in the family with protection which led us to a specific gene, and now to a specific drug target. We believe that we can leverage nature’s success at protecting people with Marfan syndrome, by using a drug that mimics the effect of the modifier gene.  :30

Dietz says approaching the issue from this perspective could have broad application for many disorders and diseases with a genetic basis. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Genes may point the way to effective treatment for Marfan’s syndrome, Elizabeth Tracey reports

Marfan syndrome is characterized by defects in the connective tissue in the body, with some people developing life-threatening balloon-like lesions in the body’s largest blood vessel, the aorta, known as aneurysms. Hal Dietz, a Marfan’s expert at Johns Hopkins, says a new approach to how to ask research questions relative to the disorder has yielded fruit.

Dietz: The basic question we’re asking is how does nature protect some, but not all people with Marfan’s syndrome from aortic enlargement and aortic tear? In families with Marfan syndrome we’ve observed rare families where half the people with the Marfan mutation have severe aneurysm and the other half are protected. We decided to use genetic methods to identify the gene responsible for the protection.   :31

Dietz and colleagues have pursued this line of inquiry and found new ways to potentially manage Marfan syndrome and avoid dire outcomes such as rupture of the aorta. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can assessments in middle age predict Alzheimer’s disease? Elizabeth Tracey reports

Middle-aged people with more risk factors for Alzheimer’s disease also have more of a substance called amyloid, known to be associated with the disease, in their brains, a recent study by Rebecca Gottesman and colleagues at Johns Hopkins has shown.

Gottesman: We cannot say just because there’s more amyloid in people with risk factors there’s more Alzheimer’s but right now we have no way to treat or prevent or modify risk for Alzheimer’s and we do know how to treat and prevent these other risk factors so at least having some more direct connection with something that we know happens in Alzheimer’s patients whether or not its causal is I think really meaningful in understanding how they might be linked. :21

Gottesman says those in mid-life should pay attention.

Gottesman: We did not find a similar relationship when we looked at late life risk factors so I think it’s particularly important for people to know the status of their risk factors, high blood pressure, diabetes, high cholesterol, smoking, and obesity, when they’re middle aged and to do what they can to try to modify these.   :15

 

At Johns Hopkins, I’m Elizabeth Tracey.

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